The latest updates to Blue Cross Blue Shield of Michigan's Provider Delivered Care Management program are available for review on The Physician Alliance website (under the Care Management tab), including information on both the
primary care and
specialist focused programs.

Did you know every physician practice is required to have a compliance plan? Healthcare fraud is rampant in Michigan and the federal government is cracking down on healthcare practices.

An Oakland County physician practice biller was recently ordered to pay $3,252,107 in restitution and sentenced to 50 months in prison. The biller was convicted of mail fraud and of conspiracy to commit health care fraud, wire fraud, and mail fraud. These convictions were passed down as the biller knowingly submitted fraudulent bills on behalf of a physician, for services she knew were not rendered. The physician paid her 6% of the total billings from Medicare. The case was investigated by the FBI and the U.S. Department of Health and Human Service Office of Inspector General.

How can you protect your practice from fraud and fines? There are many things you can do to make sure that you don't share this fate.

Perform an external audit to catch potential billing errors. Audits serve many functions and can help to catch mistakes before it's too late.

Train your staff on both HIPAA and compliance regulations, as well as on the potential sanctions that come with violations of regulations.

Your staff and all physicians must also be trained on billing and coding, to make sure that physicians in your practice are not upcoding or billing for services not rendered. Physician billing and coding is under constant scrutiny from the government and insurance companies.

Ensure that your practice has open lines of communication so that physicians, staff, and billers feel free to communicate their compliance concerns and questions. Make sure to have a way for all staff to anonymously report their concerns.

Follow through. Make sure to take all potential compliance concerns seriously. Investigate allegations and make the necessary changes to prevent further issues from arising. Let your staff know that you take their compliance concerns seriously.

Always remember that compliance is an ongoing process and compliance education should be ongoing at your practice.

Haven't seen TPA's patient education posters yet?
Check out the variety of materials available to your practice (complimentary to TPA members). From breast cancer screening to managing diabetes to decreasing antibiotic use, these materials focus on key quality metrics and help initiate conversations with patients. They're perfect for posting in exam rooms and waiting areas, and giving to patients as 'non-prescriptions.' Flyers and forms can be
downloaded and printed by practices, or
ordered online.